Healthcare Provider Details

I. General information

NPI: 1053141630
Provider Name (Legal Business Name): ADRIAN JORDAN FLEITAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 NW 119TH ST
MIAMI FL
33168-0298
US

IV. Provider business mailing address

995 NW 119TH ST
MIAMI FL
33168-0298
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-5700
  • Fax: 855-673-1409
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-323584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: